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Light-scattering tool may improve early identification of pancreatic cancer
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Researchers at the Center for Advanced Biomedical Imaging and Photonics at Beth Israel Deaconess Medical Center developed a novel tool designed to distinguish between benign pancreatic cysts and those that have the potential to transform into pancreatic cancer.
The device uses light-scattering spectroscopy to detect structural changes that occur in malignant or precancerous cells by bouncing light off tissues and analyzing the reflected spectrum.
Although this light-scattering spectroscopy requires additional testing, researchers have reported a 95% accuracy rate, compared with 58% for standard cytology.
“About one-fifth of pancreatic cancers develop from cysts, but not all lesions are cancerous,” Lev T. Perelman, PhD, director of the Center for Advanced Biomedical Imaging and Photonics at Beth Israel Deaconess Medical Center, and professor of medicine and obstetrics, gynecology and reproductive biology at Harvard University, said in a press release. “Considering the high risk of pancreatic surgeries and the even higher mortality from untreated pancreatic cancers, there is an obvious need for new diagnostic methods to accurately identify which pancreatic cysts require surgical intervention and those that do not.”
HemOnc Today spoke with Perelman about the novel tool and its potential clinical implications.
Question: How does light-scattering spectroscopy work?
Answer: The thinking behind this approach is rather straightforward. Instead of employing fluorescence or a similar sensitive biochemical change method, we use light scattering, which is sensitive to tissue architectural changes on the subcellular scale. In some ways, our instrument performs virtual real-time histopathology. With this tool, the properties of epithelial cells obtained from light-scattering spectra in vivo during a clinical procedure can be directly related to the properties of the same cells extracted via biopsy and later studied under the microscope during a real histopathology procedure.
Q: Can you describe the need for this type of predictive tool?
A: Pancreatic cancer is the deadliest cancer because the pancreas is hidden so deep inside the body, and because initial stages of pancreatic cancer are asymptomatic. Sometimes when patients undergo abdominal CT or MRI imaging for unrelated causes, pancreatic cysts are found. In the majority of cases, these cysts are benign. Unfortunately, they can be cancerous or precancerous and, therefore, deadly. Often when cysts are small, the course of action is to follow the patient with MRI or CT scans to see if the cysts grow over time. However, if a cyst is not too small, there is no accurate technique to determine whether that cyst is benign or malignant and, thus, has to be removed. The best available method is endoscopic ultrasound-guided fine-needle aspiration EUS-FNA), but it is not accurate enough. Our new technique can be combined with the EUS-FNA and significantly improve its ability to detect malignancy.
Q: What are the potential clinical implications of the tool?
A: Light-scattering spectroscopy based techniques have been under development for more than a decade and have been used in the esophagus, colon, oral cavity and more. This is the first application of the tool in pancreatic cancer. If employed in clinic, it can dramatically reduce the number of unnecessary pancreatic surgeries for benign cysts, while malignant cysts that otherwise could be missed may be identified.
Q: What further research is needed?
A: In terms of science, our studies demonstrated the proof of principle, and the majority of the research questions have been answered. Of course, for this technology to become clinical, a commercial entity that licenses our patent would need to perform a larger clinical trial followed by the FDA approval process, which is the standard route for commercialization of such instruments. This process could take several years.
Q: Is there anything else that you would like to mention?
A: There are promising emerging optical spectroscopic imaging techniques — such as light-scattering spectroscopy — that have been under development for detecting early cancer in various organs of the body and are now being tested in clinic. Hopefully, they will become clinically available soon. Since early cancer often is curable, these techniques can have a transformative effect on how we deal with cancer. – by Jennifer Southall
Reference:
Zhang L, et al. Nature Biomed Eng. 2017;doi:10.1038/s41551-017-0040.
For more information:
Lev T. Perelman, PhD, can be reached at Center for Advanced Biomedical Imaging and Photonics, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Dana 879, Boston, MA 02215; email: ltperel@bidmc.harvard.edu.
Disclosure: Perelman reports no relevant financial disclosures. The researchers report grants from National Science Foundation and NIH.